6262 E Broadway Road, Suite 106, Mesa, AZ 85206 info@pulsehealthcaresolutions.com 480-590-5146

Before Your Visit

Patient questionnaires

Completing the questionnaire for your age group before your appointment helps your provider understand your needs and make the most of your visit. Your answers are reviewed with you and are not a diagnosis.

Child

Ages 8–11

Screen for Child Anxiety Related Disorders (SCARED)

Screens for signs of anxiety. Completed by the parent and the child.

Ask our office for this form: 480-590-5146

SNAP-IV Teacher and Parent Rating Scale

Rates attention, activity level and behavior. Completed by a parent and a teacher.

Ask our office for this form: 480-590-5146

Short Mood and Feelings Questionnaire

A short check-in on mood and feelings over the past two weeks.

Ask our office for this form: 480-590-5146

Teen

Ages 11–17

SNAP-IV Teacher and Parent Rating Scale

Rates attention, activity level and behavior. Completed by a parent and a teacher.

Ask our office for this form: 480-590-5146

Teen Questionnaire

Helps us understand your teen’s concerns before the first visit.

Ask our office for this form: 480-590-5146

Adult

Ages 18+

Adult Questionnaire

Helps us understand your concerns before your first visit.

Ask our office for this form: 480-590-5146

Adult ADHD Self-Report Scale (ASRS)

A self-check for common signs of ADHD in adults.

Ask our office for this form: 480-590-5146

These forms are not for emergencies. In a crisis, call 911 or dial 988.

Online Booking

Make time for your health

Pick an available time online and we’ll confirm the details with you.

Call Book Appointment